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Recognizing elder abuse
By Alandra Johnson / The Bulletin
Published: July 24. 2009 4:00AM PSTIllustration by Greg Cross / The Bulletin
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After her son moves in, an older woman has lost a lot of weight, her hygiene has gone downhill and she is missing payments on her bills.
A younger female has started accompanying an older man every time he goes to the bank, and instead of depositing his retirement checks, he asks for the money in cash.
An elderly woman with dementia cowers whenever her caregiver is near and has stopped talking to her neighbors.
These could all be signs of elder abuse, which comes in many forms, the most common of which are financial exploitation and neglect.
Adult Protective Services, which covers the tri-county area, receives 50-70 calls a month from individuals wishing to report potential elder abuse. But national and local experts working in the field believe the problem to be much greater than the reports convey. The National Center on Elder Abuse estimates just one in five cases of elder abuse gets reported and between 1 million and 2 million Americans 65 or older have been mistreated, exploited or abused.
Part of the problem is that few people know what elder abuse is; fewer still know how to report it.
“It’s really common for people to have no idea we exist,” said Doug Breuer, a local supervisor with Adult Protective Services, known as APS, with the Department of Human Services, Seniors and People with Disabilities Division. “The vast majority of cases don’t get reported.”
At best, Breuer estimates the department sees about 10 percent of the actual cases.
Elder abuse
Elder abuse comes in many forms: financial exploitation, neglect, self-neglect, abandonment, physical abuse, emotional abuse and sexual abuse.
Breuer says there are three specialists in the local office of APS who investigate allegations of abuse, and each has about 15-20 cases right now. Breuer estimates the department investigates about half of the calls it gets.
Of those, about 30 to 40 percent are substantiated and a small number of those are prosecuted.
Breuer explains this is because not every charge is a violation of the law.
Oregon receives fewer reports of elder abuse per capita than any other state reporting the data. In 2004, the state received 0.4 reports of elder abuse for every 1,000 individuals 60 or older. The national average was closer to six reports for every 1,000 seniors. Breuer isn’t certain why Oregon receives so few reports, but he suspects it’s because fewer people are reporting abuse and not because there are fewer actual cases.
“People don’t know what to look for,” said Sgt. Scott Beard, sergeant of detectives with the Deschutes County Sheriff’s Office.
Beard says investigating elder abuse is difficult and requires a great deal of research because the victim may not be able to recall details about an incident or may be unaware money has been stolen.
Sharon Merriman-Nai, the co-manager for the National Center on Elder Abuse, believes this problem doesn’t garner much attention because of the population it affects.
“Ageism really does factor into this.”
Victims and perpetrators
The older victims can often be reluctant to turn in an abuser. Some are unaware of the abuse due to dementia and declining cognitive abilities. Others are aware but don’t want to lose their connection to a loved one, according to Breuer. Or they fear their caregiver, who is also the abuser, will abandon them and they will end up in a nursing home.
Dementia is a significant risk factor for elder abuse, according to Merriman-Nai. Also, those with dementia are sometimes not able to tell someone about the abuse, or if they do say something, they may not be believed.
Elder abuse cases are unique, says Bend attorney Lisa Bertalan, who helped create Oregon’s statutes against elder abuse in the early 1990s. “Oftentimes your best witness is incompetent.”
According to an article in the Geriatric Times, studies have shown in addition to dementia, other risk factors for elder abuse include advanced age, physical frailty and an inability to complete many tasks of daily living, such as dressing, eating and going to the bathroom. Other risk factors include drug or alcohol abuse on the part of the caregiver and a lot of physical and psychological demands placed on the caregiver.
“The most prevalent abuser, amazingly enough, is (an adult) child,” said Bertalan.
Caregiving can be a trying job. Bend resident Jacqueline Thea became a professional conservator and guardian 20 years ago after an experience caring for her aunt. The woman could be feisty and would sometimes try to fight Thea.
“It’s hard. They get mean sometimes and you lose patience.”
The stress of the experience can cause the caregivers to snap, and sometimes this results in abusive behavior. Thea has intervened in many situations in which an older individual was being taken advantage of. She is appointed to handle financial decisions with the person’s finances and sometimes medical issues. One client has lost almost all of her money after her son spent it on drugs and gambling. Other times, she is appointed when relatives fight and cannot agree how to proceed.
In financial abuse cases, often it’s an adult child who has power of attorney and is a caregiver.
The perpetrators of elder abuse are often individuals in a position of trust, according to Merriman-Nai. Often, it is a relative. Other times it is a professional caregiver. There are also some career criminals who prey on the elderly.
“Just like with child abuse, there are predators,” said Bertalan. “(The eldery are) an easy mark, especially an elderly person with dementia.”
Financial exploitation
Financial abuse is an area of elder abuse that seems to be on the rise. And many in the field expect, with the downturn in the economy, it will only grow worse.
A report from MetLife Mature Market Institute in 2009 showed seniors lost at least $2.6 billion annually to financial exploitation. The report showed the typical victim of financial abuse was between 70 and 89 years old and was female, frail and cognitively impaired.
Bertalan has seen many abuses involving power of attorney.
“Even though you have power of attorney, that doesn’t mean you can use the money for your benefit and gain,” said Bertalan.
She recalls a case of one son stealing his mother’s assets to feed his gambling problem, going through more than $100,000 of her money before he was prosecuted. Then there was a woman who was being cared for by a couple. When her money ran out, they dumped her at a nursing home.
Bertalan says perpetrators often use threats to get what they want. “If you don’t deed over your house to me, I am not going to care for you.”
Breuer has seen this kind of financial exploitation affect all income levels, from people taking very small amounts to millions.
“More often than not, it’s a relative,” Breuer said. That said, seniors are often targeted by scams, either through the mail or through the Internet. He knows of many mail fraud cases. Many seniors respond to the mail scams because the “highlight of many seniors’ (lives) is the mail.” They get excited and view these frauds as opportunities.
Bertalan recently worked on a case in which a woman’s father gave away more than $20,000 to people claiming to be serving God, although they were just con artists. “Undoing all that can be a legal nightmare,” Bertalan said. “That happens in our community a ton and you wouldn’t even know it.”
Seniors are often reluctant to admit they were fooled. “There’s a certain pride factor,” Bertalan said.
She says individuals can put more protections in place regarding powers of attorney. They can require bank accounts be monitored or that the powers of attorney not take effect until an individual becomes incompetent.
Neglect
The most common form of elder abuse is self-neglect, which is very different from other types of abuse because it doesn’t involve an outside perpetrator. But it can be very damaging. Self-neglect is when an individual can no longer care for himself or herself. The individual will let hygiene slip, the housework pile up and live in generally unsafe or unhealthy conditions. If an individual understands his or her living conditions and chooses to live in that way, that is OK. Self-neglect describes individuals who can simply no longer take care of themselves. In these cases, the investigator may contact mental health services, try to find a care provider, contact family members and try to find the senior services.
“It’s really tricky, particularly with those who don’t want to accept our help,” said Breuer.
Neglect can also come from outside. A caregiver may feel overwhelmed and unable to keep up with care, and the senior ends up suffering. Bertalan has seen cases where one older individual is caring for his or her spouse. “The situation can go downhill very rapidly.”
Spotting it
Self-neglect and neglect can be associated with malnutrition, dehydration, an inability to dress oneself, or living in unsafe or unsanitary environment. Other things to watch for include the smell of urine or the person walking outside in bare feet during the winter.
Physical abuse is associated with bruises and broken bones. Yelling and making threats may be a sign of emotional abuse. Also, Merriman-Nai says a person can see the results of emotional abuse: an older person will become withdrawn.
Financial abuse may be characterized by a person complaining about not having enough money for medication, no longer seeming to have what they need, unexplained large withdrawals of money, the addition of names to bank accounts, or more. The study from MetLife added these warning signs of abuse: a senior showing fear or submissiveness to the caregiver, being isolated from family and friends, making new “best friends,” uncharacteristic missed payments or appointments, and missing belongings.
Merriman-Nai thinks individuals do not need to be certain about the abuse before reporting it. Confirming and investigating abuse is the job of the authorities. “If an older person is telling you something, believe it enough to make the call.”
Preventing it
“More awareness on loved ones’ part would go a long way to help preventing some of this stuff,” Breuer said. “People need to ask more questions about how their loved ones and associates are doing.”
If hiring an outside caregiver, make sure to do research on the individual and call references. Check out a particular care facility and its history. And once something is in place, be sure to follow up.
Maintaining good health, independence and well-being are the best ways to prevent elder abuse, according to Merriman-Nai. Also good nutrition and regular visits to a doctor are good prevention techniques. Isolation is a risk factor, so staying active and involved is a good idea.
Bertalan and other local partners are trying to form a new nonprofit to help seniors in need. The group, called Central Oregon Guardianship and Assistance Program, would provide professional conservators or guardians to individuals who cannot otherwise afford the services. The organization would also oversee the professionals, to ensure the seniors were protected. This group, which is still seeking funding, is in direct response to a case against a volunteer conservator who stole thousands from seniors in Central Oregon. Oliver Lee Trussell was sentenced earlier this year to six years in prison for stealing more than $110,000 from clients.
“He was taking what little money these people had,” said Bertalan.
She says estate planning is key, but it can also be a curse if not done properly.
“You could be putting someone as a trustee who is not honest.”
If a relative is going to care for an older individual, both parties should create a care agreement and sign it. This agreement should outline the person’s responsibilities as well as any benefits he or she is going to receive. Bertalan says this can help head off squabbling among siblings, when the son or daughter who cared for the parent ends up receiving some financial gain.
Just raising awareness about the issue also helps.
“My goal is to bring (awareness of) elder abuse to the level of child abuse,” said Bertalan. “Our elderly population is as vulnerable as children (in some cases).”
Alandra Johnson can be reached at 541-617-7860 or at ajohnson@bendbulletin.com.
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